Techno Dinosaur April 8, 2012

Techno Dinosaur April 8, 2012

Today there are multiple issues from me, the techno dinosaur.  When I try to do stuff on the computer or the internet, some days I just get frustrated.

My favorite web site for doctors to bitch and complain has just gone to the cloud.  Now, half the time I try to check in, I get:

 Sorry, we were unable to locate the page you requested.

It might have been removed or might be temporarily unavailable. If you typed the page address in the address bar, please make sure that it is spelled correctly and try again. Or, you can go to our HOME PAGE and try a new Search for Postings.

Return to the (name removed to protect the guilty) homepage

I have posted a question about this, but their tech people won’t be in until tomorrow. 

I also tried to copy you a really cool youtube video that someone had on their web site.  All I could get was the URL.  I have no idea why.

Computer Guy was working on my office computer last week.  He works while gaming with my kids after being fed my Mr. Lasermed.  I took the computer back to the office and found out he had deleted the entire office medical record system.  Unfortunately, the kids were out of school, so I went in late.  I found this out 15 minutes before I was supposed to start patients.

AAARRRGGGHHH!

I hope Computer Guy is having a great vacation with his real family.  My computer is waiting for him when he comes back.  (He restored it before he left).

 

Medical Software Company SNAFU

This is the time of year that I bought my Electronic Medical Record Software.  Every year you have to pay for “support”.  This costs almost half as much as the software cost when purchased new.  I’m sure that it will increase in price annually.  The support people are available if I have any problems.  Like the cable company is available if you have a problem with your cable.  Enough said? 

I was thinking it was time to pay the support bill.  The other day I checked my online banking, and – SURPRISE!!!! – they had taken their money out of my checking account.  There was no warning.  No: “Dear Dr. Lasermed – next week we are going to take a huge chunk of money out of your checking account.”  Nothing.  I got an e-mail the day they took the money.

I generally don’t authorize anyone to take things out of my accounts without letting me know first.  I don’t have credit cards.  I only have debit cards.

I called the company.  They said “it’s in your contract”.  The contract is 8 pages of little tiny legal printing.  They didn’t say that they warned me a year ago.  They also said they assumed that the card was a credit card. 

I spoke with the nice people at my bank.  They have dealt with this problem before.  If I deposited cash before closing, there wouldn’t be a problem.  I could write a letter to the company so they didn’t do that again.  Check and check.  Blood pressure is beginning to come down. 

It’s amazing how the only times I ever have problems with my account are when some business takes something they are not authorized to do.  The woman at the software company said “THEIR SOFTWARE IS NOT SET UP TO SEND NOTIFICATION BEFORE THEY DO ANY BILLING”.  I want to know why they can’t fix their software, since that’s what they do, write software?  She really didn’t know. 

EMR Rant – 4 – Templates and Other Fixtures

Techno-Dino (that would be me) is still having issues with that ol’ electronic medical record.  It has things in it that make no sense.  At least to me. 

For example – if the page ends and needs a signature near the bottom, it will almost always put the signature on another page.  I print everything out, because I don’t trust this computer record (dinosaur, remember?).  So I waste a whole piece of paper saying I electronically signed the record. 

I have tried to write letters to consultants on the blasted thing.  It is not yet worth it.  Maybe I will figure it out within the decade.  After all, this is only 2011.  I couldn’t change any spacing of paragraphs, lines, etc.  I’ve been word processing since 1975 (give or take a couple of years – yes, I really am that old, folks), and can’t figure out how to get this one to behave. 

I finally just opened up “Word” and wrote the danged letter over.  I have decided to do this from now on.  I may even save a copy of my letterhead as a shortcut on the desktop because I know how to do that.  I really am somewhat computer literate. 

I’m still learning how to make my own “templates” for things like “normal GYN exam” and stuff.  I probably do a lot more typing than I really need to do. 

Plus, for some reason, now the EMR has spell checker.  However, it doesn’t know how to spell any of the medical words – you know medications, procedures, instruments and other stuff I use all the time.  This includes medications and directions it puts in itself.  So I have to teach it to spell things I didn’t put in – it did????

Remember, this is supposed to make your visit simpler???  I know that the government wants to collect data from these notes.  That’s probably all they are good for.  I’m not sure they are even good for that. 

Electronic Medical Record Rant 3

Barriers to Care

Doctors are speaking out more and more about electronic
medical records.  As a general rule, we’re not really fond of them.  There are lots of different reasons:

·        Some of us don’t type all that well.  It’s just a fact of life that your average 60 year old doesn’t touch type at 70 to 80 words per minute.  This is one time I’m glad I’m “above average”.

·        Many of the EMRs have a touch screen that you have to pick various places and go from screen to screen to enter data.  They were not designed by the people who are actually using them.

·        I feel that it puts a barrier between me and my patient.  Before, when I was talking to my patient, I would lean on the chart, making small notes if needed, and fleshing them out later.  Now I sit behind a laptop and type off and on the whole time I am talking to the patient.  It feels impersonal.

·        My EMR won’t print out the bill until the note is complete.  So, I have to have the note finished before the patient leaves if she wants a receipt.

·        Perhaps we are mistaken about this process.  There are NO written instructions, just a very confusing web site.  We get referred there with questions.  Tech support isn’t very helpful with the little things. 

·        Remember, I’m a dinosaur.  Chat rooms just don’t cut it for me.  My 17 year old kids have given up on helping me with this, too.  Princess knows less than I do about computers. 

·        I have paper charts that go back literally 27 years.  There is NO way I can enter all that data into the computer.  Nor do I want to.  I usually start with: “This patient has been seen since 1987.  She has an extensive paper chart that will NOT be summarized here….”

·        I started a medication flow sheet in 1995.  When someone asks for “that medicine that you gave me that worked for….” I just flip through the sheets until I find it.  Not going to enter these, either.  I think they have fixed the program so it will enter from now on.  I’m not sure.  The update was just last week. 

AAAARRRRGGGGHHHH!!!!!

Electronic Medical Record Rant 2

Meaningful Use

Last week my EMR got updated.  I’m finally almost making peace with software, so they have to change it.  They tell me that they are getting rid of some bugs and updating so I can meet “meaningful use criteria”. 

The gobment has criteria that they want every chart to cover in order to meet their criteria for “meaningful use” of the EMR.  So far I have discovered some of them.

1.     They want me to ask every one of my patients if she smokes, how much, and for how long.  I’m not sure what that has to do with a yeast infection, but…..

2.     Every patient is to have a height and weight, so we can determine a BMI.  This stands for body mass index.  The gobment wants to know if you are fat.

3.     They have not fixed the ranges for height.  A woman under 5’ or over 5’10” is out of range for the EMR.

4.     I must give a certain number of my patients written educational materials and document this.  If I don’t meet their %, I don’t get Medicare incentive money.  Since I don’t participate with Medicare, I don’t care about this.

5.     I must give a certain percentage of my patients written instructions and document this.  Same issue as #4.

There is no place for

1.     Did you explain to the patient what is wrong with them?

2.     Did you answer all the patient’s questions?

3.     I have a GYN practice.  Every patient is female.  One statistic I really need is when a woman had her last period.  There is NO place for this.  My pediatrics, family practice and several other specialty friends say that this is important to them, also. 

They did build in some sort of medication sheet that will follow which medications are prescribed by date.  This is encouraging.  Now, if I could only figure out how to get the sheet that I have been keeping since 1995 loaded into the computer…. (Oh, computer geeks, where are you?)

Meaningful use is hard to do when you are an old fart.

Electronic Medical Record Rant 1

The Computer is NOT Always Right

The gobment wants us to use the electronic medical record (EMR).  They say it makes everything easier.  They want us to prescribe medications through the computer.  They even pay Medicare providers more if they do this.  We are trying to be good little followers. 

It’s not working.

Yesterday, I checked on a medication I wanted to use.  It is still listed in the computer version of the PDR – or all the drugs that are currently made.  OK.  It is also listed in the formulary in my EMR.  I clicked on it and sent it through the internet. 

This morning promptly at 8 AM, the patient called.  Her husband picked up her prescription.  It wasn’t the medication we talked about.  She had gotten it before.  This looked totally different etc. 

The pharmacy didn’t open until 9 AM.  I called, went through the menu, and spoke to the chipper pharmacy assistant.  She referred me to the equally chipper pharmacist.  I’ll start calling pharmacies at 9:00 from now on.  They are really zippy that early.

The pharmacist told me that the medication was off the market.  That’s why I had checked all those places.  Usually if a medication is discontinued, it is marked that way, both in the formulary and in the drug reference.  I thought it had been discontinued over a year ago, which is why I checked.  I know I can’t trust my brain.  It turns out I can’t trust my computer, either.

Electronic Medical Record – 0

Electronic Prescriptions – 0

Real People – 1

Sometimes the old way is better.